Clear cell renal cell carcinoma: Machine learning-based computed tomography radiomics analysis for the prediction of WHO/ISUP grade

•More than 90 % of the ccRCCs were correctly classified using the ML-based CT radiomic analysis.•The performace was nip and tuck among different classifiers.•Excellent reproducibility was achieved in ICC analysis. To evaluate the performance of machine learning (ML)-based computed tomography (CT) radiomics analysis for discriminating between low grade (WHO/ISUP I-II) and high grade (WHO/ISUP III-IV) clear cell renal cell carcinomas (ccRCCs). A total of 164 low grade and 107 high grade ccRCCs were retrospectively analyzed in this study. Radiomic features were extracted from corticomedullary phase (CMP) and nephrographic phase (NP) CT images. Intraclass correlation coefficient (ICC) was calculated to quantify the feature’s reproducibility. The training and validation cohort consisted of 163 and 108 cases. Least absolute shrinkage and selection operator (LASSO) regression method was used for feature selection. The machine learning (ML) classifiers were k-NearestNeighbor (KNN), Logistic Regression (LR), multilayer perceptron (MLP), Random Forest (RF), and support vector machine (SVM). The performance of classifiers was mainly evaluated and compared by certain metrics. Seven CMP features (ICC range, 0.990-0.999) and seven NP features (ICC range, 0.931-0.999) were selected. The accuracy of CMP, NP and the combination of CMP and NP ranged from 82.2%–85.9 %, 82.8%–94.5 % and 86.5%–90.8 % in the training cohort, and 90.7%–95.4%, 77.8%–79.6 % and 91.7%–93.5 % in the validation cohort. The AUC of CMP, NP and the combination of CMP and NP ranged from 0.901 to 0.938, 0.912 to 0.976, 0.948 to 0.968 in the training cohort, and 0.957 to 0.974, 0.856 to 0.875, 0.960 to 0.978 in the validation cohort. ML-based CT radiomics analysis can be used to predict the WHO/ISUP grade of ccRCCs preoperatively.